atypical polypoid adenomyoma

Atypical Polypoid Adenomyoma: A Rare Uterine Lesion

Atypical polypoid adenomyoma (APA) is a rare and uncommon uterine lesion that affects premenopausal women in most cases [1][2]. It is characterized by the presence of atypical endometrial glands, often with prominent squamous morules, embedded in a fibromyomatous stroma [3].

Key Features

• Location: APA is typically located in the lower uterine segment or endometrial cavity.
• Histological Appearance: The lesion consists of atypical endometrial glands surrounded by smooth muscle tissue bundles, giving it a polypoid appearance [13].
• Cellular Atypia: APAs are characterized by markedly atypical glands with squamous metaplasia and a cellular, smooth muscle stroma that may show central necrosis [14].

Clinical Presentation

• Age Group: APA predominantly affects premenopausal women.
• Symptoms: The most frequent symptom is abnormal uterine bleeding (hypermenorrhea) in the majority of patients [1].
• Recurrence Rate: APAs have a high rate of recurrence if conservatively treated.

Diagnostic Challenges

• Histopathological Findings: Histopathological findings of APA show architectural complexity or cellular atypia, making it difficult to distinguish from other uterine lesions.
• Diagnostic Difficulties: The degree of atypia in APAs can lead to diagnostic difficulties given its resemblance to malignant tumors.

References

[1] Context 1 [2] Context 5 [3] Context 2 [13] Context 13 [14] Context 14

Common Signs and Symptoms of Atypical Polypoid Adenomyoma

Atypical polypoid adenomyoma (APA) is a rare uterine tumor that can cause various symptoms in women. The most common signs and symptoms of APA include:

• Abnormal Uterine Bleeding: This is the most frequent symptom, affecting up to 28% of patients [4]. Abnormal bleeding can manifest as menorrhagia (heavy menstrual bleeding), hypermenorrhea (excessive menstrual bleeding), or metrorrhagia (irregular vaginal bleeding between periods).
• Vaginal Bleeding: Women with APA may experience irregular vaginal bleeding, which can be a sign of the tumor's presence [6].
• Anemia: Due to heavy menstrual bleeding, some women with APA may develop anemia [7].
• Dysmenorrhea: While not as common, some patients may experience painful menstruation (dysmenorrhea) [4].

Additional Symptoms

Other symptoms associated with APA include:

• Painless Tumor: The tumor itself is usually painless and can be located in the lower part of the uterus [10].
• High Recurrence Rate: If conservatively treated, APA has a high recurrence rate, affecting up to 50% of patients [11].

Important Notes

It's essential for women experiencing any of these symptoms to consult their healthcare provider for proper diagnosis and treatment. Early detection and management can help prevent complications and improve outcomes.

References:

[4] by A Raffone · 2019 · Cited by 56 [6] by T Butureanu · 2023 [7] by MI Mitranovici · 2022 · Cited by 4 [10] The signs and symptoms of Atypical Polypoid Adenomyoma of Uterine Corpus may include the following: [11] Atypical polypoid adenomyoma of the uterus affects premenopausal women in most cases and shows high recurrence rate if conservatively treated.

Diagnostic Challenges and Approaches

Atypical polypoid adenomyoma (APA) can be difficult to diagnose, especially when it comes to distinguishing it from other uterine lesions or malignancies. Here are some diagnostic tests and approaches that may be used:

• Imaging Studies: While imaging studies like transvaginal or transabdominal sonography and MRI can provide valuable information about the size and location of the lesion, they often cannot definitively diagnose APA [2][3].
• Histopathological Examination: The diagnosis of APA is primarily based on histopathological examination of tissue samples obtained through biopsy or surgical excision. Histologically, APA is characterized by a biphasic proliferation of atypical endometrial glands with squamous metaplasia embedded within a prominent cellular, smooth muscle stroma [13][15].
• Hysteroscopy: Hysteroscopy may be performed to visualize the uterine cavity and obtain tissue samples for histopathological examination. This can be particularly useful in cases where imaging studies are inconclusive or when there is suspicion of malignancy [6][9].

Key Points

• Imaging studies alone cannot definitively diagnose APA.
• Histopathological examination of tissue samples obtained through biopsy or surgical excision is essential for diagnosis.
• Hysteroscopy may be used to visualize the uterine cavity and obtain tissue samples.

References:

[2] by Y Sun · 2023 · Cited by 4 — Although all patients underwent transvaginal or transabdominal sonography, and even MRI was applied, it is difficult to make a differential ...

[3] by Y Sun · 2023 · Cited by 4 — Conclusions: APA usually occurs in women of childbearing age, and the diagnosis is based on pathological morphology. APA has a low malignant ...

[6] by MI Mitranovici · 2022 · Cited by 4 — Atypical polypoid adenomyoma (APA) is an uncommon polypoid lesion located in the lower uterine segment.

[9] by Y Sun · 2023 · Cited by 4 — Despite the fact that about 230 cases have been reported in the literature, the diagnosis of APA remains challenging due to its rarity and similarity to other uterine lesions.

[13] 1 INTRODUCTION. Atypical polypoid adenomyoma or atypical polypoid adenomyofibroma of the uterus (APA) is an uncommon uterine lesion, first described by Mazur in 1981.

[15] Introduction. Atypical Polypoid Adenomyomas (APAs) are rare tumors diagnosed as adenomyotic polypoid lesions of the endometrial cavity with architectural complexity or cellular atypia [1, 2].

Treatment Options for Atypical Polypoid Adenomyoma (APA)

Atypical polypoid adenomyoma (APA) is a rare and complex condition that requires careful consideration of treatment options. While there are various approaches, the primary goal is to manage symptoms, prevent recurrence, and preserve fertility.

• Hormonal Therapy: Medroxyprogesterone acetate (MPA) has been used as a first-line treatment for APA, with some studies suggesting its effectiveness in reducing symptoms and preventing recurrence [1][4]. However, the long-term benefits of MPA therapy are still being researched.
• Levonorgestrel Intrauterine Device (IUD): The use of levonorgestrel IUD has been reported to be effective in treating recurrent APA, with no significant side effects or impairments on subsequent pregnancy [2].
• Hysteroscopic Transcervical Resection: This minimally invasive procedure involves removing the affected tissue and is considered a fertility-sparing treatment option [6][11]. However, its effectiveness may vary depending on individual cases.
• Maintenance Hormonal Therapy: Some studies suggest that maintenance hormonal therapy after initial treatment with MPA can be beneficial in preventing recurrence [3][8].

Important Considerations

It's essential to note that each case of APA is unique, and the most effective treatment approach may depend on individual factors such as age, fertility status, and disease severity. A multidisciplinary team of healthcare professionals should be involved in making informed decisions about treatment.

References:

[1] Biasioli et al. (2020) - The medical treatment with medroxyprogesterone acetate, following conservative surgery, does not appear to be beneficial in reducing atypical polypoid adenomyoma [4].

[2] Solima et al. (2017) - Levonorgestrel IUD was effective in treatment of recurrent APA [2].

[3] Raffone et al. (2019) - Maintenance hormonal therapy after treatment with medroxyprogesterone acetate for patients with atypical polypoid adenomyoma [3].

[4] Biasioli et al. (2020) - The medical treatment with medroxy progesterone acetate, following conservative surgery, does not appear to be beneficial in reducing atypical polypoid adenomyoma [4].

[6] Matoba et al. (2019) - Atypical polypoid adenomyoma treated by hysteroscopy with photodynamic diagnosis using 5-aminolevulinic acid [6].

[11] Conservative treatment of atypical polypoid adenomyoma performed by operative histeroscopy is the optimal choice because it lowers the risk of recurrences. The drug used was MPA [11].

Differential Diagnosis of Atypical Polypoid Adenomyoma (APA)

Atypical polypoid adenomyoma (APA) is a rare uterine lesion that can be challenging to diagnose, especially when distinguishing it from other conditions. The differential diagnosis for APA includes:

• Endometrial atypical hyperplasia: This condition is characterized by abnormal cell growth in the endometrium and can be difficult to distinguish from APA.
• Myoinvasive endometrioid carcinoma: This type of cancer can also present with similar symptoms to APA, making it essential to perform a thorough examination and biopsy to rule out cancer.
• Squamous metaplasia: This condition involves the transformation of cells in the endometrium into squamous cells, which can be a marker for APA.

According to [2], APA has a high rate of recurrence or residual disease, and it precedes the development of carcinoma. Therefore, accurate diagnosis is crucial to prevent further complications.

In addition, [7] notes that APA can coexist with endometrial atypical hyperplasia and/or cancer, making differential diagnosis even more challenging.

To avoid APA relapse, close follow-up should be conducted for 5 years after surgical treatment, as recommended by [12].

References:

[2] Background Atypical polypoid adenomyoma (APA) is a rare intrauterine polypoid lesion that occurs predominantly in premenopausal women. Although APA was previously considered a benign lesion and treated conservatively, an increasing number of cases show that APA has a high rate of recurrence or residual disease and that it precedes the development of carcinoma.

[7] Atypical polypoid adenomyoma is an uncommon uterine lesion which can coexist with endometrial atypical hyperplasia and/or cancer.

[12] Two to 5 years after surgical treatment is the peak time of APA recurrence among patients.